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Role of the Radiologist in Cardiac Diagnostic Imaging

Martin J. Lipton1, Lawrence M. Boxt2 and Ziyad M. Hijazi3

1 Department of Radiology, University of Chicago, MC 2026, 5841 S. Maryland Ave., Chicago, IL 60637.
2 Department of Radiology, Beth Israel Medical Center, First Ave. and 16th St., New York, NY 10003.
3 Department of Pediatrics, University of Chicago, MC 4051, 5841 S. Maryland Ave., Chicago, IL 60637.



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  		Hollis E. Potter 24th President of ARRS 1923-1924

 


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  		George W. Holmes 25th President of ARRS 1924-1925

 


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  		Fig. 1A. —47-year-old man with 33-mm secundum atrial septal defect. Four-chamber view of transesophageal echocardiogram without color Doppler sonography shows atrial septal defect (arrow) before insertion of device. RA = right atrium, RV = right ventricle, LA = left atrium, LV = left ventricle.

 


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  		Fig. 1B. —47-year-old man with 33-mm secundum atrial septal defect. Same image as A with color Doppler sonography shows atrial septal defect (arrow) and left-to-right shunt before device closure.

 


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  		Fig. 1C. —47-year-old man with 33-mm secundum atrial septal defect. Same four-chamber view as A without color Doppler sonography shows device after closure of defect.

 


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  		Fig. 1D. —47-year-old man with 33-mm secundum atrial septal defect. Same type of image as A with color Doppler sonography after closure with 38-mm Amplatzer septal occluder (AGA Medical, Golden Valley, MN) shows good device position and no residual shunt.

 


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  		Fig. 2A. —5-year-old boy with continuous heart murmur. Cinearteriogram shows descending aorta in lateral projection with 3.0-mm patent ductus arteriosus (arrow).

 


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  		Fig. 2B. —5-year-old boy with continuous heart murmur. Cinearteriogram after closure with 8- to 6-mm Amplatzer duct occluder (AGA Medical, Golden Valley, MN) shows complete immediate closure of ductus (arrow) in this patient.

 


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  		Fig. 3A. —Chest radiographic examination in 54-year-old man with history of previous myocardial infarction. Posteroanterior radiograph shows increased curvature of dilated left ventricle. Although left atrial appendage segment (arrow) is concave, pulmonary vessels in lower lobes are less sharp than those in upper lobes, indicating left atrial hypertension. Faint rimlike calcification of left ventricular aneurysm (arrowheads) may be seen through ventricular contour.

 


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  		Fig. 3B. —Chest radiographic examination in 54-year-old man with history of previous myocardial infarction. Lateral image shows dilated left ventricle (LV) and calcification of anteroseptal LV aneurysm (arrowheads).

 


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  		Fig. 4. —62-year-old man with history of recent acute myocardial infarction. Contrast-enhanced CT scan shows apical left ventricular (LV) aneurysm. Note calcification (arrow) on anterior LV wall, behind which lies unenhanced thrombus, sharply cutting off LV cavity (arrowheads). Thinned anteroseptal myocardium contrasts with compensated and hypertrophied posterior LV wall.

 


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  		Fig. 5. —59-year-old man with shortness of breath. Contrast-enhanced CT scan shows calcified and thickened pericardium (arrows) along right and left heart borders. Right ventricle (RV) is compressed by thickened pericardium and is tubular in appearance. Right atrium is enlarged and atrioventricular groove is prominent, both hallmarks of pericardial constriction.

 


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  		Fig. 6. —Contrast-enhanced helical CT scan of 63-year-old man with chronic aortic regurgitation. Dilated aortic root (Ao) and normal left atrium (LA) are opacified. In addition, contrast material increases visualization of left main artery (arrowhead) and calcified anterior descending (short arrow) and circumflex (long arrow) coronary arteries.

 


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  		Fig. 7. —Short-axis spin-echo MR image of 63-year-old man with chronic stable angina pectoris shows increased signal in papillary muscle (long arrow) and posterior left ventricular myocardium (short arrows) ischemia in circumflex coronary artery territory.

 


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  		Fig. 8. —Contrast-enhanced spin-echo MR image obtained during acute myocardial infarction in 54-year-old man. Apical left ventricular myocardial infarct (arrow) is seen to enhance. (Courtesy of Duerinckx A, Dallas, TX)

 


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  		Fig. 9. —Contrast-enhanced K-space-segmented gradient-reversal MR image reconstructed in coronal section in 54-year-old man shows origin of left main coronary artery (arrow) from posterior left sinus of Valsalva (L).

 


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  		Fig. 10. —Systolic short-axis tagged MR image of 42-year-old man with hypertrophic cardiomyopathy. Note asymmetric posterior left ventricular thickening (arrow). Furthermore, changes in tagging intersections are less pronounced in this region of myocardial disarray.

 


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  		Fig. 11. —Diagrammatic representation shows atherosclerotic plaque with homogeneous lipid core and platelet-rich thrombus overlying thin but intact cap. This is early unruptured plaque in its early developmental phase of endothelial erosion. (Reprinted with permission from [64])

 


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  		Fig. 12. —Diagram illustrates plaque disruption in classic "shoulder" region. Lipid-rich core contents are seen escaping into arterial lumen. Mixture of blood, platelets, thrombin fibrinogen, and lipids is extremely volatile and may cause sudden vessel occlusion, embolism, or spasm. (Reprinted with permission from [64])

 


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  		Fig. 13. —Graph shows accelerating pace of introduction of new diagnostic imaging technologies and applications since 1891. Note how many tools and applications have appeared between 1972 and 1990. PET = positron emission tomography.

 

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